| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF WISCONSIN | $17K | $0 | $17K | 9.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 245 SOUTH EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $0 | $7K | 6.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $3K | $0 | $3K | 9.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | FOUR EVER LIFE INSURANCE COMPANY | $170 | $17 | $187 | 5.52% |
| ANTHEM INSURANCE COMPANIES, INC.3 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 46204 | FOUR EVER LIFE INSURANCE COMPANY | $169 | $17 | $186 | 5.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 245 SOUTH EXECUTIVE DRIVE SUITE 200 BROOKFIELD, WI 53005 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $35 | $35 | — |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 374 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 379 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FOUR EVER LIFE INSURANCE COMPANY | 374 | $3K |
| Dental | DELTA DENTAL OF WISCONSIN | 275 | $184K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 400 | $28K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 374 | $104K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 374 | $104K |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 374 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.